Provider Demographics
NPI:1134187867
Name:SPEAKMAN, MARTA PEDZIWIATR (DDS)
Entity type:Individual
Prefix:DR
First Name:MARTA
Middle Name:PEDZIWIATR
Last Name:SPEAKMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 W PARK AVE
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-2567
Mailing Address - Country:US
Mailing Address - Phone:847-816-3440
Mailing Address - Fax:
Practice Address - Street 1:740 FLORSHEIM DR
Practice Address - Street 2:#13
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3712
Practice Address - Country:US
Practice Address - Phone:847-816-3440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0242961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice